Abstract

Objective To investigate the efficacy and safety of pulmonary bullae with refractory spontaneous pneumothorax (SP) treated with medical thoracoscopy. Methods Patient with pulmonary bullae and refractory SP treated by pouring talc, autologous blood and/or erythromycin into pleural cavity under medical thoracoscopy in our hospital within recent 5 years were collected.The efficacy and complications of these interventional methods were evaluated.Criterion for therapeutic effect: no ipsilateral SP recurrence within 12 months after thoracoscopy was considered as cure; No ipsilateral SP recurrence within 6 months was considered as improved; While ipsilateral SP recurrence within 6 months was considered as failure. Results Total 23 patients with pneumothorax were given medical thoracoscopy examination.Eight eligible cases with 10 medical thoracoscopy procedures were followed up more than 1.5 years.Removal time of chest drainage tube in patients with application of talc powder spraying with or without APC under medical thoracoscopy were 5-13 days after thoracoscopy.However, removal time with application APC without talc powder would be more than 14 days even up to 50 days no matter together with or without pouring autologous blood and erythromycin into pleural cavity.The cure rate was 90%, improved rate was 10%, and none failed.Ipsilateral SP recurrence occurred 7 months and 3 years later in 2 cases respectively.No serious complications developed. Conclusions Medical thoracoscopy for pulmonary bullae with refractory SP is an alternative effective and safe approach which deserves further investigation.Talc power spray under medical thoracoscopy is rather effective; APC is another safety method but with limited value; Autologous blood or erythromycin is recommended to inject into pleural cavity after APC utilization. Key words: Medical thoracoscopy; Spontaneous pneumothorax; Pulmonary bulla; Talc powder; Autologous blood; Erythromycin

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